Final report

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regional committee

PAN AMERICAN

HEALTH

ORGANIZATION

WORLD

HEALTH

ORGANIZATION

XXXV Meeting

Washington, D.C.

September 1989

7

XLIII Meeting

CD35/FR (Eng.) 27 September 1991

ORIGINAL: ENGLISH-SPANISH

FINAL REPORT

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Page

PREAMBLE

RESOLUTIONS

I. Appropriations for the Pan American Health Organization for 1992-1993

II. Assessments of the Member and Participating Countries of the Pan American Health Organization for 1992-1993

III. Provision for Cost of Exchange/Inflation Rate

Differential Fund

IV. Appointment of the External Auditor

V. Salary of the Director of the Pan American Sanitary Bureau

VI. Women, Health, and Development

VII. Election of Three Member Governments to the Executive

Committee on the Termination of the Periods of Office of Canada, Trinidad and Tobago, and Venezuela

VIII. Acquired Immunodeficiency Syndrome (AIDS) in the Americas

IX. Plan of Action for the Eradication of the Indigenous

Transmission of Wild Poliovirus from the Americas

X. Annual Report of the Chairman of the Executive Committee

XI. Annual Report of the Director of the Pan American Sanitary Bureau

XII. Collection of Quota Contributions

KIII. Interim Financial Report of the Director for the

Year 1990

XIV. Status of the Eradication/Elimination of Certain Diseases from the Region

XV. International Drinking Water Supply and Sanitation Decade. Report on the Situation in the Region at the End of the Decade

XVI. Maternal and Child Health and Family Planning Programs

I

1

2

4

5

6

7

10

11

12

15

16

17

19

20

22

25

I

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CD35/FR (Eng.)

CONTENTS (cont.)

Page

RESOLUTIONS (cont.)

XVII. Cholera in the Americas 28

XVIII. Debt Conversion 31

XIX. Evaluation of the Strategies for Health for All by the

Year 2000 33

XX. Amendments to the Financial Rules and Regulations of

the Pan American Health Organization 34

XXI. Establishment of a Pan American Institute for Food

Protection and Zoonoses 35

0

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-FINAL REPORT

The XXXV Meeting of the Directing Council of the Pan American Health Organization, XLIII Meeting of the Regional Committee of the World Health Organization for the Americas, was held at the Headquarters Building in Washington, D.C., from 23 to 27 September 1991, as convened by the Director of the Pan American Sanitary Bureau in compliance with Resolution I approved by the Executive Committee in its 106th Meeting.

PARTICIPANTS

The following Member and Participating Governments of the Pan

American Health Organization were represented: Argentina, Bahamas,

Barbados, Belize, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Ecuador, El Salvador, France, Grenada, Guyana, Haiti, Honduras, Jamaica, Kingdom of the Netherlands, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Lucia, St. Kitts and Nevis, Saint Vincent and the Grenadines, Trinidad and Tobago, United States of America, Uruguay and

Venezuela. The Governments of Portugal and Spain were represented by

observers.

The Executive Committee of the Pan American Health Organization was represented by its Chairman pro tempore, Dr. Mateo Budinich (Chile),

and its Vice Chairman pro tempore, Mr. Norbert Prefontaine (Canada).

Also present at the Meeting was Dr. Hiroshi Nakajima,

Director-General of the World Health Organization.

The Meeting was also attended by observers from the following

intergovernmental organizations: the Caribbean Community, the Hip6lito

Unanue Agreement, the Inter-American Commission for Women, the

Inter-American Development Bank, the Inter-American Institute for

Cooperation on Agriculture, the Organization of American States, the United Nation Childrens' Fund, the United Nations Development Program, the United Nations Economic Commission for Latin America and the Caribbean, the United Nations High Commissioner for Refugees, the United

Nations Population Fund, and the World Bank. Observers from 27

nongovernmental organizations were also present.

OFFICERS

Pursuant to Rules 18 and 20 of the Rules of Procedure of the Directing Council, Hon. Romanus Lansiquot (Saint Lucia), as Vice President of the XXXIV Meeting of the Directing Council, presided over the

proceed-ings until the election of the President. The Meeting then elected the

two Vice Presidents and the Rapporteur. The officers of the Directing

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CD35/FR Page II

OFFICERS (cont.)

President: Dr. Cynthia Prieto Conti

Vice President:

Rapporteur:

Secretary ex officio:

Hon. Easton Douglas

Col. Dr. Lisandro Vazquez Sosa

Dr. Yulit Vallejo de Gonzalez

Dr. Carlyle Guerra de Macedo

JAMAICA EL SALVADOR

VENEZUELA

DIRECTOR, PAN AMERICAN SANITARY BUREAU

COMMITTEE ON CREDENTIALS

The Committee on Credentials was appointed in accordance with Rule 27 of the Rules of Procedure, and consisted of the following members:

Dr. Carlos Castro COSTA RICA

Rapporteur: Hon. Allan Guye

Dr. Oscar Gonzalez Carrizo ARGENTINA

GENERAL COMMITTEE

With the election of the Representatives of Barbados, Cuba and the United States of America, in accordance with Rule 28 of the Rules of

Procedure, the General Committee was constituted as follows:

Dr. Cynthia Prieto Conti President of the Council

Hon. Easton Douglas

Vice President of the Council

PARAGUAY

JAMAICA

Col. Dr. Lisandro VAsquez Sosa Vice President of the Council

Dr. Yulit Vallejo de Gonzalez Rapporteur of the Council

Hon. Branford M. Taitt Representative

Dr. Ram6n Prado Peraza Representative

Mr. Neil Boyer Representative EL SALVADOR VENEZUELA BARBADOS CUBA UNITED STATES OF AMERICA

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AGENDA

In accordance with Rule 10 of the Rules of Procedure, in its first plenary session the Directing Council approved the provisional agenda (Document CD35/1, Rev. 1) presented by the Director.

DECISIONS

In its fifth plenary session the Directing Council elected Panama to membership on the Advisory Committee on Policy Coordination of the Special Program of Research, Development and Research Training in Human Reproduction, for the term from 1 January 1992 to 31 December 1994.

In the same session the Directing Council elected Venezuela to designate a person to serve on the Joint Coordinating Board of the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR), for the term from 1 January 1992 to 31 December 1994.

In this session, the Directing Council also elected Cuba to membership on the Management Committee of the Global Program on AIDS for the term from 1 January 1992 to 31 December 1994.

Also in the fifth plenary session, the Directing Council elected Argentina to membership on the Management Advisory Committee of the Action Program on Essential Drugs for the term from 1 January 1992 to 31 December 1994.

Finally, in its tenth plenary session the Directing Council

decided to take note of and to transmit to the World Health Organization the recommendation of the Advisory Committee on Health Research (ACHR) for the Ninth Jacques Parisot Foundation Fellowship Award.

WORKING PARTIES

At the first plenary session a working party was established, consisting of the Representatives of Mexico, Trinidad and Tobago, and Uruguay to study the application of Article 6.B of the Constitution of

the Pan American Health Organization. The working group prepared a

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CD35/FR (Eng.) Page IV

SESSIONS

The Directing Council held a preliminary session and ten plenary

sessions-The Committee on Credentials held three sessions and the General Committee, three sessions.

RESOLUTIONS

In the course of the Meeting, the Directing Council approved the following 21 resolutions:

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RESOLUTION I

APPROPRIATIONS FOR THE PAN AMERICAN HEALTH ORGANIZATION FOR 1992-1993

THE DIRECTING COUNCIL,

RESOLVES:

1. To appropriate for the financial period 1992-1993 n mount of S171,607,650 as follows:

PART I DIRECTION, COORDINATION AND MANAGEMENT 17,004,600

PART 11 HEALTH SYSTEM INFRASTRUCTURE 69,895,400

PART ll HEALTH SCIENCE AND TECHNOLOGY 42,400,300

PART IV PROGRAM SUPPORT 17,302,700

Effective Working Budget (PARTS I - IV) 146,603,000

==..= .... a...a..==.t.=.=...====.=. ==

...--PART V PROVISION FOR COST OF EXCHANGE/INFLATION RATE DIFFERENTIAL 5,973,000

Total Program Budget (Parts I-V) 152,576,000

PART VI STAFF ASSESSMENT (Transfer to Tax Equalization Fund) 19,031,650

TOTAL - ALL PARTS 171,607,650

B__=====_.=I=I==_= z--===,,=

2. That the appropriation shall be financed from: (a) Assessments in respect to:

Member and Participating Countries assessed under the scales adopted by the Organization of American States in accordance with Article 60 of the Pan American Sanitary Code or in accordance with Directing Council and

Pan American Sanitary Conference resolutions 155,934,650

(b) liscellaneous Income 9,700,000

(c) Provision for Cost of Exchange/Inflation Rate Differential 5,973,000

TOTAL 171,607,650

t2==- _===mz==z==

In establishing the contributions of Member and Participating Countries, their assessments shalt be reduced further by the amount

standing to their credit in the Tax Equalization Fund, except that credits of those countries which levy taxes on the emoluments received from the Pan American Sanitary Bureau (PASB) by their nationals and residents shall be reduced by the amounts of such tax reimbursements by PASB.

3. That, in accordance with the Financial Regulations of PAHO, amounts not exceeding the appropriations noted under

paragraph 1 shall be available for the payment of obligations incurred during the period 1 January 1992 to 31 December 1993, inclusive. Notwithstanding the provision of this paragraph, obligations during the financial period 1992-1993 shall be limited to the total program budget, I.e., Parts I-IV and Part V, Provision for Cost of Exchange/infLation Rate Differential. Any balance in Part V will be available to be used for this purpose in subsequent financial periods.

4. That the Director shall be authorized to transfer credits between parts of the effective working budget, provided that such transfer of credits between parts as are mode do not exceed 10% of the part from which the credit is transferred. Transfers of credits between parts of the budget in excess of 10X of the part from which the credit is transferred my be made with the concurrence of the Executive Cmarittee. Part V my be transferred entirely into Parts I-IV, if necessary. All transfers of budget credits shall be reported to the Directing Council or the Conference.

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CD35/FR Page 2

RESOLUTION II

ASSESSMENTS OF THE MEMBER AND PARTICIPATING COUNTRIES OF THE PAN AMERICAN HEALTH ORGANIZATION FOR 1992-1993

TI DIRECTING COJICIL,

RESOLVES:

To establish the assessments of the ember ind Participating Countries of the Pan American Health

Organization for the financial period 1992-1993 in accordance uith the scale of quotas shown below and in the

corrspaonding ramunts.

(3) (4)

Gross Credit from Tax

Assessment Equal at on Fund

1992 1993 1992 1993

US USS USS USS

(5)

Adjustment for Taxes Imposed By Neaber Countries

on Emoluments of PASB Staff

1992 1993

USS USS

(6)

Net

Assessmrnt

...

1992 199:

USS USI

Antigua and Barbuda

Argentina

Bahas

arbados

iel ize

loltvia

Brea i l

Chile Colaombi 0.02 5.02 0.07 0.08 0.03 0.07 8.76 10.24 0.55 0.96

Costa RicO

Cube

Dominica

Dominican Repubtic Ecuador 0.13 0.83 0.02 0.18 0.18 0.02 4.96 0.07 0.08 0.03 0.07 8.66 11.27 0.55 0.95 0.13 0.80 0.02 0.18 0.18 15,593 3,913,960 54,577 62,374 23,390 54,577 6,829,939 7,983,855 428,820 748,486 101,358 647,129 15,593 140,341 140,341 15,593 3,867,179 54,577 62,374 23,390 54,577 6,751,971 8,786,919 428,820 740,690 101,358 623,739 15,593 140,341 140,341 1,903 477,694 6,661 7,613 2,855 6,661 833,586 974,420 52,337 91,352 12,371 78,961 1,903 17,128 17,128 1,903 471,985 6,661 7,613 2,855 6,661 824,070 1,072,433 S2,337 90,400

85,000 85,000

12,371 76,127 1,903 17,128 17,128 (Eng.)

a

(1) Country .. ... . .. . . .. . .. . . (2) Scate Adjusted to PAHO Wlbership

1992 1993

X S

13,690 3,436,266 47,916 54,761 20,535 47,916 5,996,353 7,094,435 376,483

657, 134

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- )

Country

- -- -- --- - v o - - z z -

--EL SaLvador uGrnal Guaitie Haiti Hmnrlras Jamica Nexico Nicaragua Panm Paraguay Peru

t Iitts and Nevis

Pint Lucia

Saint Vincent & the Grenadines

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Scale

Adjusted to PAHO ombership

1992 1993

I Z

0.07 0.03 0.13 0.02 0.07 0.07 0.18 6.23 0.07 0.13 0.18 0.42 0.01 0.03 0.02 0.07 0.03 0.13 0.02 0.07 0.07 0.18 6.16 0.07 0.13 0.18 0.42 0.02 0.03 0.02

(3) (4) (5) (6)

Adjustment for Taxes Ilposed By

Hdber Countries

Gross Credit from Tax on Emoluments of Net

Assessment Equalization Fund PASB Staff Assessment

1992 1993 1992 1993 1992 1993 1992 1993

USS USS USS USS USS USS USS USS

54,577 23,390 101,358 15,593 54,577 54,577 140,341 4,857,364 54,577 101,358 140,341 327,463 7,797 23,390 15,593 54,577 23,390 101,358 15,593 54,577 54,577 140,341 4,802,787 54,577 101,358 140,341 327,463 15,593 23,390 15,593 6,661 2,855 12,371 1,903 6,661 6,661 17,128 592,836 6,661 12,371 17,128 39,966 952 2,855 1,903 47,916 20,535 88,987 13,690 47,916 6,661 2,855 12,371 1,903 6,661 6,661 17,128 586,175 6,661 12,371 17,128 39,966 1,903 2,855 1,903 47,916 123,213 4,264,528 47,916 88,987 123,213 287,497 6,845 20,535 13,690 47,91t 20.53s 13,69C 47.91i 47,916 123,213 4,216,612 47,91t 88,987 123,21: 287,49: 13,691 20,531 13,691 Surinme

Trinidad nd Tobago

United States of America Uruguay

Venezuela

"S totaL

0.07 0.18 60.96 0.27 3.28 99.56 0.07 0.18 60.24 0.26 3.24 99.56 . -54,577 140,341 47,528,882 210,512 2,557,328 77,624,269 54,577 140,341 46,967,518 202,715 2,526,141 77,624,269 . . . ---6,661 17,128 5,800,850 25,693 312,119 9,473,956 6,661 17,128 5,732,336 24,741 308,313 9,473,956 47,916 123,213

2,650,000 2,650,000 44,378,032

184,819

14,000 14,000 2,259,209

...749,000 279000 70,899313

2,749,000 2,749,000 70,899,313

-- - - - ...

47,91t

123,21'

43,885, 18

177,974

2,231,821

70,899,312

...-Particioatino couatries

France 0.29 0.29 226,105 226,105 27,596 27,596 19,509 198,50

Kingdom of the NetherLands 0.09 0.09 70,171 70,171 8,564 8,564 - - 61,607 61,607

United tingdom 0.06 0.06 46,780 46,780 5,709 5,709 - - 41,071 41,071

... ... . ...-.-...-.-.-...

Subtotal 0.44 0.44 343,056 343,056 41,869 41,869 - - 301,187 301,187

TOTAL 100.00 100.00 77,967,325 77,967,325 9,515,825 9,515,825 2,749,000 2,749,000 71,200,500 71,200,50D

*5= sal m SSSSSS -USS - hSESSm .. .l.. 1881fl10II USBfUISI... . ZS...fhl. .. - lS *.. ---.---- r--l----l---.-.--....

(2) This column ahow the djusted scale in respect to assessments of Hember and Participting Countries of the Pen American Health Organization.

(5) This columi includes estimeted imounts to be received by the respective Mmber Countries in 1992-1993 in respect of taxes levied by them on staff members, emoLumnts received from PASS, adjusted for wny difference betueen the estimated and actual for prior years.

(Adopted at the fourth plenary session, 24 September 1991)

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CD35/FR (Eng.) Page 4

RESOLUTION III

PROVISION FOR COST OF EXCHANGE/INFLATION RATE DIFFERENTIAL FUND

THE XXXV MEETING OF THE DIRECTING COUNCIL,

Having considered and approved the proposed program budget of the Pan American Health Organization for the biennium 1992-1993 and the report of the Director on the adverse effects of inflationary changes on it;

Aware of the impact on the Organization's regular program budget of movements of the rates of exchange between the US dollar and other regional currencies, many of which have already occurred in 1990-1991 and have adversely affected program implementation;

Conscious of the need to ensure that resources are available to the Organization to finance at least part of the additional costs that come from the exchange/inflation rate differentials; and

Believing that quota collections and revenues for the 1990-1991 biennium can be expected to exceed the Organization's approved effective

working budget of US$130,023,000 _{and that surplus funds should be placed}

in a special fund to cover costs arising from exchange and inflation rate differential fluctuations,

RESOLVES:

1. To authorize the Director to establish a special account to meet the cost of exchange/inflation rate differentials and to transfer to this account funds not to exceed $5,973,000, subject to availabilities from collections and revenues in excess of the 1990-1991 effective working budget of $130,023,000 in order to meet part of the estimated increase of cost for 1992-1993 due to these differentials arising in the 1990-1991 biennium.

2. To authorize the Director in the future to credit or debit gains and losses from exchange/inflation rate differentials to this special account.

3. To approve the availability of funds in this special account for subsequent financial periods.

(Adopted at the fourth plenary session, 24 September 1991)

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RESOLUTION IV

APPOINTMENT OF THE EXTERNAL AUDITOR

Bearing in mind that it has been the practice of the Pan American Health Organization and the World Health Organization to have the same External Auditor, and that the holder of the Office of the Comptroller and Auditor General of the United Kingdom of Great Britain and Northern Ireland, who has been appointed External Auditor of the World Health Organization for the financial periods 1992-1993 and 1994-1995, has expressed a willingness to continue to serve as External Auditor of the Pan American Health Organization,

RESOLVES:

1. To appoint the holder of the Office of the Comptroller and Auditor General of the United Kingdom of Great Britain and Northern Ireland External Auditor of the accounts of the Pan American Health Organization for the financial periods 1992-1993 and 1994-1995, and to request that he conduct his audits in accordance with the principles set forth in Article XII of the PAHO Financial Regulations, with the provi-sion that, should the need arise, he may designate a representative to act in his absence.

2. To express its thanks to Sir John Bourn for the work he has performed for the Organization in his audit of the accounts for the financial periods 1986-1987 and 1988-1989.

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RESOLUTION V

SALARY OF THE DIRECTOR OF THE PAN AMERICAN SANITARY BUREAU

Considering the revision made to the schedule of salaries for the

professional and higher categories of staff in graded posts, effective 1 March 1991;

Taking into account the decision by the Executive Committee at its 107th Meeting to adjust the salaries of the Deputy Director and the Assistant Director (Resolution CE1O7.R13);

Having noted the recommendation of the Executive Committee

concerning the salary of the Director of the Pan American Sanitary Bureau (Resolution CE107.R13); and

Bearing in mind the provisions of Staff Rule 330.3,

RESOLVES:

To establish the annual net salary of the Director of the Pan American Sanitary Bureau at US477,639 (dependency rate) or $69,628

(single rate), effective 1 March 1991.

(Adopted at the fifth plenary session, 25 September 1991)

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RESOLUTION VI

WOMEN, HEALTH, AND DEVELOPMENT

Having considered the Final Report of the Special Subcommittee on Women, Health and Development (Document CD35/12);

Aware of the importance of fully involving professional women in the Secretariat in attaining the goals of the Organization and in decision-making within the Organization, and in view of the inadequate progress made in these areas, as indicated in part in the Report on the Situation of Women in the Secretariat (Document SMSDll/9); and

Having regard to the resolutions adopted previously by the

Governing Bodies of PAHO on Women, Health and Development, and

particularly Resolutions CSP22.R12 of the XXII Pan American Sanitary Conference and CD32.R9, CD33.R6 and CD34.R5 of the XXXII, XXXIII and XXXIV Meetings of the Directing Council, respectively,

RESOLVES:

1. To request the Member Governments to:

a) Strengthen their strategies and plans of action for

improving the quality of education, the sociocultural,

economic and legal situation and the living and health

conditions of women by taking a com'prehensive,

decentralized approach which addresses the health and

social needs of all women;

b) Foster the promotion and recruitment of women to the managerial levels of the health sector;

c) Devise and adopt monitoring and evaluation methods that will document the progress made in implementation of the strategies and plans of action referred to in the fore-going paragraph;

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e) Establish and tighten bonds of collaboration between the agencies responsible for health and those responsible for

women's affairs, so that their programs will use resources

efficiently and avoid duplication of efforts;

f) Establish and tighten bonds of collaboration between the

agencies responsible for health and women and

non-governmental organizations, universities and research

centers working for the benefit and health of women, in the formulation and implementation of joint projects;

g) Facilitate the admission of the spouses of international civil servants to their labor markets;

h) Participate actively in the Technical Discussions on Women, Health and Development to be conducted at the next World Health Assembly in May 1992;

i) Strengthen the arrangements for social participation by women in promoting the health of communities, enterprises and education centers.

2. To congratulate the Director for the accomplishments, to date, of the Program on Women, Health and Development, and particularly for its technical cooperation with the countries in the Region, and for his support of the development of that program as an integral activity of the Organization.

3. To recommend to the Director that he continue to strengthen

the Organization's program on Women, Health, and Development, in

particular that he:

a) Promote the establishment of mechanisms for coordination and collaboration between the Program on Women, Health and Development and the Organization's other programs so that program activities address, as a priority, the needs and concerns of women in the Region; and

b) Intensify the actions of the Program on Women, Health and Development, and the identification and development of projects for technical cooperation at the national level and among countries (TCAC).

In addition, to recommend to the Director that he:

c) Pursue vigorously increased recruitment, hiring and

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d) Take a leadership role, in consultation with other international agencies and organizations and with Member States, to find solutions to the employment problems of the spouses of international civil servants.

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CD35/FR (Eng.)

Page 10

RESOLUTION VII

ELECTION OF THREE MEMBER GOVERNMENTS TO THE EXECUTIVE COMMITTEE ON THE TERMINATION OF THE PERIODS OF OFFICE

OF CANADA, TRINIDAD AND TOBAGO, AND VENEZUELA

Bearing in mind the provisions of Article 9.B and 15.A of the Constitution of the Pan American Health Organization; and

Considering that the Governments of Honduras, Peru, and St. Vincent and the Grenadines were elected to serve on the Executive Committee upon the termination of the periods of office of Canada, Trinidad and Tobago, and Venezuela,

RESOLVES:

1. To declare the Governments of Honduras, Peru, and St. Vincent and the Grenadines elected to membership of the Executive Committee for a

period of three years.

2. To thank the Governments of Canada, Trinidad and Tobago, and Venezuela for the services rendered to the Organization during the past

three years by their representatives on the Executive Committee.

(Adopted at the fifth plenary session, 25 September 1991)

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RESOLUTION VIII

ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) IN THE AMERICAS

Having examined the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CD35/14);

Recalling and reaffirming Resolution XIX of the XXIII Pan American Sanitary Conference;

Having regard for the difficulties of undertaking national,

regional and global efforts to prevent AIDS and human immunodeficiency virus (HIV) infection as identified therein; and

Considering the need for a concerted, continuous effort to reduce

the social and economic consequences of the AIDS epidemic and of

increasing HIV infection rates in the Americas,

RESOLVES:

1. To support the lines of action and biennial goals of the AIDS Program in the Americas as presented in Document CD35/14.

2. To recommend to the Member Governments that they place special emphasis on evaluating the effectiveness and efficiency of activities carried out under their national HIV and AIDS prevention and control

programs, especially in the areas of infection prevention and health

education.

3. To urge the Member Governments to promote the development of activities in the areas of research, technology transfer, and the dissemination of technical and scientific information.

4. To recommend to the Member Governments that they intensify

activities designed to influence health behavior and prevent HIV

infection through an approach based on intersectoral integration and decentralization to the state, provincial, and community levels.

5. To request the Director of the Pan American Sanitary Bureau to continue the Organization's support to national AIDS and HIV prevention and control programs through interprogram efforts coordinated both in Headquarters and in the Country Offices.

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CD35/FR (Eng.)

Page 12

RESOLUTION IX

PLAN OF ACTION FOR THE ERADICATION OF THE INDIGENOUS TRANSMISSION

OF WILD POLIOVIRUS FROM THE AMERICAS

Having considered and examined the progress report presented by the Director (Document CD35/15 and ADDs. I and II) on the implementation of the Expanded Program on Immunization and the Plan of Action for the Eradication of Indigenous Transmission of Wild Poliovirus from the Americas;

Noting with satisfaction that: a) immunization coverage levels

for children under one year of age have achieved at least 75% for each of the vaccines included in the program (DPT, polio, measles, and BCG), the highest level ever achieved in the Americas; b) transmission of wild poliovirus has been virtually interrupted in the Hemisphere, with only 17 cases reported in 1990 and only two during the first six months of 1991;

and c) considerable progress has been made in regard to strategies to

control or eliminate neonatal tetanus and measles;

Recognizing that considerable efforts will be needed to:

a) achieve final eradication of indigenous transmission of wild

poliovirus in the few remaining foci; b) maintain and increase the

overall immunization coverage levels; c) control or eliminate neonatal

tetanus and measles; and d) include new vaccines in the national

immunization programs; and

Concerned that the global shortage of EPI vaccines, particularly

measles and polio, could jeopardize the efforts of countries in

maintaining the immunization coverage already achieved and the control of the EPI diseases,

RESOLVES:

1. To congratulate all Member Governments and their health

workers on the progress achieved so far, which demonstrates their high level of commitment to the health of the children of this Hemisphere.

2. To express appreciation and request continued support from the

various agencies (AID, UNICEF, IDB, Rotary International, and the

Canadian Public Health Association) which, together with PAHO, have given strong support to the national immunization programs and efforts to eradicate poliomyelitis.

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3. To commend the Organization for its enthusiastic, outstanding support of the Member Governments' efforts to implement their national immunization programs and eradicate poliomyelitis.

4. To urge Member Governments to adopt the "Priorities for

Action" described in Chapter II of the Progress Report (Document

CD35/15), to ensure that:

a) Immunization coverage is monitored by "municipios" and that missed opportunities for vaccination are eliminated;

b) All vaccines used in the program conform to the minimum requirements of PAHO/WHO;

c) Weekly negative reports are transmitted in a timely manner from all health facilities included in the surveillance system and that the PAHO reward of $100.00 for any person reporting the first confirmed polio case of an outbreak is widely publicized by all countries;

d) "Mop-up" operations are properly implemented, with two rounds of house-to-house vaccination, one month apart, in which all children under five years of age living in a wide

area, usually encompassing several districts, receive one

dose OPV in each round, regardless of their previous

vaccination status;

e) The surveillance system records separately neonatal and post-neonatal tetanus cases, and that vaccination programs are implemented in those districts already identified as at risk;

f) Human and financial resources are assigned to the program

in the national health budgets and in the 1991-1996

national EPI Work Plans.

5. To request the Director to:

a) Apply all the needed measures to ensure the final inter-ruption of transmission of wild poliovirus in the Western Hemisphere;

b) Evaluate the strategies for measles control/elimination being used in Cuba and the English-speaking Caribbean and the feasibility of their implementation in the rest of the Western Hemisphere;

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CD35/FR (Eng.)

Page 14

d) Continue aggressive efforts to mobilize the needed

additional resources to face the challenges described in the Progress Report;

e) To take the necessary actions to address the issue of

vaccine shortage, with the aim of achieving regional

self-sufficiency in all matters of vaccine production and quality control;

f) Report on the progress of the program to the XXXVI Meeting

of the Directing Council in 1992.

(Adopted at the seventh plenary session, 26 September 1991)

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RESOLUTION X

ANNUAL REPORT OF THE CHAIRMAN OF THE EXECUTIVE COMMITTEE

Having considered the Annual Report of the Chairman of the Executive Committee (Document CD35/8) on the work of the Committee from

September 1990 to date, the period during which the 106th and

107th Meetings were held; and

Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization,

RESOLVES:

1. To take note of the Annual Report of the Chairman of the Executive Committee (Document CD35/8).

2. To congratulate the Chairman and the other members of the Executive Committee on their excellent work.

(23)

RESOLUTION XI

ANNUAL REPORT OF THE DIRECTOR OF THE PAN AMERICAN SANITARY BUREAU

Having examined the Annual Report of the Director of the Pan American Sanitary Bureau on the activities of PAHO during 1990 (Official Document 243); and

Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization,

RESOLVES:

1. To take note of the Annual Report of the Director of the Pan American Sanitary Bureau for 1990.

2. To congratulate the Director for his constant efforts to make the Report a dynamic working tool that accurately reflects the work done by PAHO and assists in evaluating the execution of the cooperation activities carried out during the period covered.

3. To thank the Director for his leadership and support to the Member Governments in the technical cooperation activities carried out by

PAHO during 1990.

(Adopted at the seventh plenary session, 26 September 1991)

(24)

RESOLUTION XII

COLLECTION OF QUOTA CONTRIBUTIONS

Having considered the report of the Director on the Collection of

Quota Contributions (Document CD35/21 and ADD. I) and the concerns

expressed by the 107th Meeting of the Executive Committee with respect to the status of the collection of quota contributions;

Noting the report of the Working Party on the application of Article 6.B of the PAHO Constitution relating to the suspension of voting privileges of Member Governments that fail to meet their financial

obligations to the Organization (Document CD35/21, ADD. II);

Recognizing that, in the case of the seven Member Governments subject to Article 6.B, Guyana and Bolivia through recent payment action are no longer subject to Article 6.B; and

Further noting that Antigua and Barbuda, the Dominican Republic, Guatemala, Haiti, and Suriname are not present at this Meeting of the Directing Council,

RESOLVES:

1. To take note of the report of the Director on the Collection of Quota Contributions (Document CD35/21 and ADD. I).

2. To express appreciation to those Member Governments that have already made payments in 1991, and to urge all Member Governments in arrears to meet their financial obligations to the Organization in an expeditious manner.

3. To congratulate Guyana and Bolivia for their payment efforts to reduce quota arrears for prior years.

4. To recognize the concern expressed at the meeting of the Working Party with respect to the future voting privileges of Antigua and Barbuda and to request the Director to advise the Government of the views of the Council.

(25)

6. To endorse the Working Party's recommendation that all deferred

payment plans be considered firm commitments by the countries concerned and not be modified in the future.

7. To request that the Director:

a) Continue to monitor the implementation of special payment agreements made by Member Governments in arrears for the payment of prior years' quota assessments;

b) Advise the Executive Committee of Member Governments'

compliance with their quota payments' commitments;

c) Report to the XXXVI Meeting of the Directing Council on the status of the collection of quota contributions for 1992 and prior years.

(26)

RESOLUTION XIII

INTERIM FINANCIAL REPORT OF THE DIRECTOR FOR THE YEAR 1990

Having examined the Interim Financial Report of the Director for

the Year 1990 (Official Document 242); and

Noting the report of the 107th Meeting of the Executive Committee

on its review of the financial statements and schedules of the

Organization as contained in Official Document 242,

RESOLVES:

1. To take note of the Interim Financial Report of the Director for the Year 1990.

2. To endorse the comments and concerns expressed by the 107th

Meeting of the Executive Committee in its report on the financial

condition of the Organization as of 31 December 1990, and in particular the concern expressed with respect to the impact that the delayed payment

of quota assessments may have on the financial status of the

Organization's Centers in Jamaica and Guatemala.

3. To commend the Director for having maintained the Organization in a satisfactory financial condition.

(27)

CD35/FR (Eng.)

Page 20

RESOLUTION XIV

I

STATUS OF THE ERADICATION/ELIMINATION OF CERTAIN DISEASES

FROM THE REGION

Having seen Document CD35/16 on the status of the eradication/ elimination of certain diseases from the Region;

Having regard to Resolution XVI of the XXIII Pan American Sanitary Conference; and

Recognizing that some countries have eradicated or eliminated poliomyelitis, neonatal tetanus, urban rabies and foot-and-mouth disease, that the decision has been made to eliminate measles (in the Caribbean), and that it is feasible to seek to eradicate or eliminate from the Region

of the Americas other communicable diseases such as American

trypanosomiasis transmitted through blood transfusion, leprosy, the

nonvenereal treponematoses and onchocerciasis, and micronutrient

deficiencies,

RESOLVES:

1. To adopt the recommendations contained in Document CD35/16 for the elimination, eradication or control of certain diseases.

2. To urge the Member Governments:

a) To continue giving priority to the effective prevention,

control and surveillance of diseases preventable by

immunization until they are eliminated;

b) To foster the necessary collaboration and coordination between the different levels of the public sector, and between it and the private sector, for the completion and execution of updated plans of action to prevent, control, and maintain surveillance of:

i) the following infectious diseases: American

trypano-somiasis transmitted by blood transfusion, leprosy, the

nonvenereal treponematoses (yaws and pinta), and

onchocerciasis; and

ii) deficiencies of the following micronutrients: iodine and vitamin A;

(28)

c) To introduce activities for the prevention and control of these diseases in their local health systems and encourage community participation and local programming so that the measures taken will be comprehensive and make use of all available resources.

3. To request the Director:

a) To promote the mobilization of institutional, human and financial resources in the countries, the Region, and the rest of the world for the development and use of the health system infrastructure, especially the local health systems

(SILOS), in effective and consistent control programs;

b) To foster the establishment, strengthening and proper

functioning of epidemiological services that can analyze health situations, risk factors, and the characteristics of

ecosystems, and evaluate social and health services;

c) Promote technical cooperation for the development of

epidemiological programs and surveillance in joint efforts

for the preservation of transmission-free areas;

d) Support the development of managerial and administrative capabilities at the lowest decision-making levels in order

to promote local programming and the evaluation of

prevention, control and surveillance methods in local

situations.

(29)

CD35/FR (Eng-) Page 22

RESOLUTION XV

INTERNATIONAL DRINKING WATER SUPPLY AND SANITATION DECADE. REPORT ON THE SITUATION IN THE REGION AT THE END OF THE DECADE

Having seen the document presented by the Director on the

evaluation of the International Drinking Water and Sanitation Decade (IDWSSD) (1981-1990);

Recalling Resolution XXII of the XXVI Meeting of the Directing Council of PAHO (1979), Resolution WHA36.13 (1983) and WHA39.20 (1986) on the Decade, which recognized water supplies and sanitation as essential elements for the achievement of Health for All by the Year 2000;

Noting the efforts made by the governments, the contribution of the external support agencies (ESA) and the achievements of the IDWSSD program;

Noting the efforts made by the governments and the Director in the

national and regional evaluation of the IDWSSD;

I

Noting that several countries of the Region were unable to attain their national goals due to the unfavorable socioeconomic condition in the Region and other factors;

Noting that the IDWSSD program has created considerable awareness of the need for water supplies and sanitation as essential elements for primary health care;

Noting further that the continued expansion of poor urban marginal areas where water and sanitation services are deficient constitutes high risks for transmission of diseases, particularly typhoid and cholera; and

Taking into account the recommendations of the Declaration of New Delhi, the Declaration of Puerto Rico, and the recommendations of the Director concerning a plan of action for IDWSSD,

RESOLVES:

1. To urge Member Governments to:

a) Renew their political commitment to the improvement of water supplies and sanitation services, and to reiterate the importance of the relationship of health to access to adequate water supplies and sanitation services;

(30)

b) Intensify, with urgency, the action needed for the formula-tion and implementaformula-tion of programs and projects to increase further the coverage of water supplies and of sewerage and excreta disposal services, particularly in poor marginal urban and rural areas, and to promote the rehabilitation of existing services where such services have shown signs of deterioration;

c) Improve water quality through the protection of water sources, including the treatment of waste that may affect them, and the improved management of water treatment and distribution systems;

d) Define policies and promote practices for water

conserva-tion, including the control of water losses, and to

optimize the use of existing systems through better

operation, maintenance, and more efficient use of the

facilities, and through the education of consumers about the conservation and use of water;

e) Define effective policies and promote practices for

financial and engineering management of the systems that will provide more sustainable services, including appro-priate recovery of costs with due regard for social equity and the adoption of appropriate technology;

f) Promote social mobilization in the water and sanitation sector, involving communities in planning, financing and managing water and sanitation services;

g) Develop national monitoring and management information

systems to improve knowledge of conditions in the sector and provide the basis for decision-making.

2. To urge bilateral, multilateral and nongovernmental coopera-tion agencies to:

a) Recognize the importance of water and sanitation for

socioeconomic development and to promote research in this area;

b) Increase their financial contribution to the water and sanitation sector in order to help the countries meet their respective objectives;

c) Develop effective mechanisms for coordination of sector

activities within the external support community;

(31)

3. To request the Director to:

a) Continue to give high priority to the promotion of the

development and efficient management of basic water

supplies and sanitation services in the countries, with emphasis on urban and rural poor and high-risk groups;

b) Develop, as soon as possible, a plan of action to guide and support the countries in their efforts to implement the recommendations of the Declarations of New Delhi and Puerto Rico toward the achievement of water and sanitation goals, within the strategy of Health for All by the Year 2000;

c) Assist the countries in developing and maintaining a

national information system to monitor and evaluate program progress as well as sector and regional progress;

d) Support actively actions which are complementary to water and sanitation programs, and to increase their sanitary and health impact; these actions should include education and

training programs, research, technology development,

information exchange, and community participation;

e) Continue to work closely with bilateral and multilateral cooperation agencies towards optimizing resource

mobiliza-tion and to promote intersectoral collaboration among

national sector agencies;

f) Support technical cooperation efforts among the countries

through the strengthening of subregional and regional

professional organizations.

g) Encourage translation of the results of the current country evaluation on programs and projects carried out during the Water Decade into effective action plans for programs during the decade of the nineties.

(Adopted at the eighth plenary session, 26 September 1991)

(32)

RESOLUTION XVI

MATERNAL AND CHILD HEALTH AND FAMILY PLANNING PROGRAMS

Having considered Document CD35/17 on maternal and child health

and family planning programs, which contains the third progress report

presented by the Director on execution of the Organization's action policy on population matters;

Having regard to the progress made in execution of the strategies recommended by the XXIII Pan American Sanitary Conference in 1990 and by the Directing Council of PAHO in its meetings of 1984, 1985 and 1988;

Considering the present state of development of the national pro-grams in the field of maternal and child health and family planning, and of the areas that require strengthening;

Cognizant of the improvement in the indicators of maternal and child health and family planning in the population of Latin America and the Caribbean at the close of the eighties and of their expected trends in the nineties; and

Mindful of the commitments undertaken by the Presidents and Heads of State of the Americas in the Declaration of the World Summit for

Children,

RESOLVES:

1. To urge the Governments:

a) To review and update their national maternal and child health and family planning programs before December 1991 so

that they will reflect the spirit, strategies and goals recommended in their respective plans of action;

b) To promote at the central, regional and local levels in their countries the decisions and commitments of the Sum-mit, and to call upon the public and private sectors to join in attaining the national goals on behalf of women and children;

(33)

d) To facilitate _{obtaining better working conditions for}

mothers and reducing the unemployment of parents of

children under one year of age;

e) To give priority in their actions to i) coverage of as yet neglected geographic areas, ii) marginal urban and rural population groups, and iii) comprehensive care of women, children and adolescents, with strengthened sexual and health education, and to make efforts to improve the quality of care in order to close existing gaps;

f) To strengthen the establishment and consolidation of inter-agency coordination mechanisms for maternal and child health, through a committee to be headed by a Government employee with decision-making authority;

g) To continue developing their epidemiological surveillance systems and data bases for improved monitoring and evalua-tion of programs;

h) To ensure that in their countries the aspects of

popula-tion, development, _{health and reproductive health are}

covered in their reports and proposals at the International Conference on Population in 1994;

i) To continue implementing the recommendations and resolu-tions issued by the Governing Bodies of PAHO in the area of maternal and child health and population;

j) To give special attention to comprehensive care for

preschool children through strategies for the stimulation of their optimal growth and development.

a) To continue his guidance of technical cooperation in the field of maternal and child health towards execution of the mandates of the Governing Bodies in support of implementa-tion of the Plan of Acimplementa-tion of the World Summit for Children, in keeping with the strategic priorities of the quadrennium, especially by participating actively with the countries in each phase of development and in the imple-mentation of national maternal and child health plans;

b) To continue his efforts to find and support strategies for financing, and the mobilization of national and interna-tional resources;

(34)

d) To promote, in conjunction with the Governments, the

forma-tion and development of interagency committees as an

arrangement for making better use of existing resources.

e) To include on the agenda of the next meeting of the

Direct-ing Council the topic of "Comprehensive Health of

Adolescents."

3. To take note of the "Memorandum of Interagency Collaboration to Support Implementation of the Agreements of the World Summit for

Children in the Region of the Americas" and to commend and express its satisfaction to the Heads of the signatory agencies for the actions taken

in developing an interagency work plan for 1991-1992 which will

contrib-ute to achieving the common goal of promoting the health of children, adolescents, and women in the Region.

(Adopted at the eighth plenary session,

(35)

CD35/FR (Eng-) Page 28

RESOLUTION XVII

CHOLERA IN THE AMERICAS

Considering the spread of the cholera epidemic in several countries of the Region;

Recognizing that, in face of the threat of introduction of the disease to other countries of the Region, concrete measures must be adopted to limit its spread and to prevent mortality and reduce morbidity from the disease;

Cognizant that the parenteral vaccines presently available are not recommended for the prevention or control of cholera;

Aware of the link between the occurrence of cholera and the socio-economic and sanitary situations in affected areas;

Cognizant of the Director's initiative to coordinate the

Organization's response to this emergency;

Informed of the subregional action of the Andean and Central American countries to prepare coordinated plans for dealing with the emergency and to reinforce preparations against the threat; and

Informed of the general strategy proposed by the Organization to address the problem, and of Resolution WHA44.6,

RESOLVES:

1. To call upon the international community to intensify its cooperation with the countries affected or threatened by cholera.

2. To urge the international and regional agencies concerned to give more priority to granting to these countries the technical and financial cooperation they may request for their struggle against cholera.

(36)

4. To urge the Member Governments:

a) To report any case of cholera immediately, in compliance with the International Sanitary Regulations;

b) Not to apply to countries affected by the epidemic

restrictions on passenger transit and imports of products from those countries which are not justified from the standpoint of public health;

c) To establish and execute national plans for the prevention and control of cholera which identify the most vulnerable

areas and population groups, allocate the resources

required to launch those plans, assure use of an

intersectoral approach, address the need for effective

social communications, and indicate the need for

international technical and financial cooperation in the context of the Organization's general strategy;

d) In the countries yet untouched by the epidemic, to

strengthen their capabilities for epidemiological

surveillance, control of the quality of drinking water, basic sanitation and food protection and control, social communication, strengthening of diarrhea control programs

with emphasis on proper case management, public

information, and health personnel training.

a) To strengthen measures that will ensure a prompt and effective response by the Organization to the needs of

countries affected or threatened by cholera;

b) To assure that the Organization plays an active, creative role in mobilizing resources from all sources to provide the countries in the Region with the financial support required for their cholera prevention and control plans;

c) To coordinate regional measures against cholera so that technical and financial resources will be put to the most efficient possible use;

d) To continue activities for the development and evaluation of effective new vaccines against cholera;

e) To continue his efforts, in collaboration with the Member Governments and interested agencies and organizations, to implement the proposed general strategy by drawing up plans, programs and projects for its implementation and

(37)

f) To prepare, in close collaboration with the Member

Countries and other cooperation agencies, a long-term plan of investment in health and the environment for meeting the infrastructural requirements in those areas.

(38)

RESOLUTION XVIII

DEBT CONVERSION

Considering that:

The economic crisis in the countries of the Region and their

policies for adjusting to it have reduced the resources available to the health sector;

Several initiatives have been undertaken to convert the external indebtedness of countries in the Region into local currency and to obtain additional resources for the financing of socioeconomic development projects, the initiatives having been conducted in negotiations by the debtor countries with private banks and in the area of bilateral relations, as in the case of President Bush's Enterprise for the Americas

initiative;

Consideration is being given to the possibility of converting the indebtedness to the public sectors of the Club of Paris countries for application in social projects in the debtor countries;

Other United Nations agencies are making trial of debt conversions to finance social projects; and

The health sector has hitherto benefitted very little from these initiatives,

RESOLVES:

1. To recommend to the economic and health authorities in the

PAHO/WHO Member Countries that they explore the possibilities of

converting part of their respective debts into local currency for the financing of health projects and, if they consider this course feasible, that they establish the mechanisms needed to implement such operations.

2. To urge the creditor countries, the international financing agencies and the private banks to extend to the developing countries in the Region debt conversion facilities for the financing of projects in the health sector as in other sectors.

(39)

4. To request the Director of PASB to support the Member

Countries in their efforts to attract resources for the financing of health projects through external debt conversion, in the promotion of this mechanism at the international level, and in the formulation, execution and evaluation of the resulting projects, and to report to the XXXVI Meeting of the Directing Council on the progress of his efforts in

this direction.

(40)

RESOLUTION XIX

EVALUATION OF THE STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000

Having examined the document presented by the Director to the XXXV

Meeting of the Directing Council on the Second Evaluation of the

Strategies for Health for All by the Year 2000 and primary health care (Document CD35/19); and

Mindful of the commitments undertaken by the Member States of WHO in the Thirty-ninth World Health Assembly (Resolution WHA39.7, 1986) on the presentation of monitoring reports on these matters,

RESOLVES:

1. To approve the document presented by the Director and to request that he send it to WHO as the regional report, with the changes suggested by the Members of the Regional Committee.

2. To request that an in-depth review be carried out of the instruments used for monitoring and evaluation, which are regarded as in need of adjustment for a proper response on the part of the countries.

3. To call for a renewal of the commitment of the Member Countries of the Region to the Strategies of Health for All by the Year

2000 and to primary health care, which provide the indispensable

conceptual framework for addressing the epidemiological, socioeconomic and financial situation of the sector in the last decade of the 20th century.

(41)

RESOLUTION XX

AMENDMENTS TO THE FINANCIAL RULES AND REGULATIONS OF THE PAN AMERICAN HEALTH ORGANIZATION

Having considered the recommendation of the Executive Committee and the proposed changes in the Financial Regulations proposed in Document CE107/24; and

Taking into consideration that the changes in the Rules and

Regulations will provide conformity between the Financial Rules and

Regulations of WHO and PAHO with respect to the availability of

appropriations,

RESOLVES:

To approve the changes in the Financial Rules and Regulations of the Pan American Health Organization as they appear in Document CE107/24.

(42)

RESOLUTION XXI

ESTABLISHMENT OF A PAN AMERICAN INSTITUTE FOR FOOD PROTECTION AND ZOONOSES

Taking note of the negotiations during the period June-September 1991 between the Government of Argentina and the Director of the Pan American Sanitary Bureau for the establishment of a Pan American Institute

for Food Protection and Zoonoses;

Considering the importance for all Member Countries to have an international institute for providing technical cooperation with regard to reference, research and information in matters of food protection, the strengthening of official public health laboratories, and zoonoses; and

Acknowledging the interest and generous commitment of the Govern-ment of Argentina to host the Institute in its territory,

RESOLVES:

1. To congratulate the Government of Argentina and the Director of the Pan American Sanitary Bureau for the negotiations towards the

establishment of a Pan American Institute for Food Protection and

Zoonoses (INPPAZ) and to approve the establishment of this Institute as a Pan American Center in accordance with Resolution CSP20.R31 of the XX Pan American Sanitary Conference (4 October 1978).

2. To authorize the Director of the Bureau to sign an agreement with the Government of Argentina along the lines of the draft agreement included in Annex I (Part B) of Document CD35/27, and to make the

necessary legal and administrative arrangements to formalize the

agreement and implement it.

3. To express profound appreciation to the Government of Argentina for its interest and commitment to host the Institute.

4. To request the Director to report next year to the Governing Bodies of PAHO on the installation and initial development of INPPAZ.

(43)

IN WITNESS WHEREOF, the President of the Directing Council and the Secretary ex officio, Director of the Pan American Sanitary Bureau, sign the present Final Report in the English and Spanish languages, the two texts being equally authentic.

DONE in Washington, D.C., United States of America, on this

twenty-seventh day of September, nineteen hundred and ninety-one. The

Secretary shall deposit the original texts in the Archives of the Pan American Sanitary Bureau and shall send copies thereof to the Member Governments of the Organization.

Cynthia Prieto Conti President of the

XXXV Meeting of the Directing Council Representative of Paraguay

Carlyle Guerra de Macedo

Secretary ex officio of the Directing Council Director of the